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This course explains how insurers, insurance adjusters, and insurance special investigation unit investigators work to prevent insurance fraud (obtaining funds from an insurer wrongfully and illicitly). It explains staged losses, fake thefts, paper property, arson for profit, false documentation, and other efforts to defraud an insurer. The course also explains what is necessary to prove fraud as a defense to an insurance claim.
The course covers the following:
- The use of investigators to gather evidence establishing that a fraud is being attempted.
- The various types of fraud attempted against first party property policies.
- Understanding the staged accident.
- Understanding the use of paper property.
- How to discover an arson for profit.
- How to prove that an insured is involved in an arson for profit.
- How to discover health insurance fraud.
- How to recognize professional conspiracies.
- How to recognize fraud in the legal profession.
- How to act in good faith and fair dealing with regard to insurance fraud.
Learning Objectives
- Explore how the fraud perpetrator’s use of the covenant of good faith and fair dealing to defeat insurer’s claim of attempted insurance fraud.
- Recognize the elements insurance fraud and the proof needed to assert fraud as a defense.
- Identify what investigation will be performed to stop fraud.
- Explore how the statutory requirement to thoroughly investigate potential fraud makes successful fraud difficult.
Last updated/reviewed: November 17, 2019
Included In Certifications
This course is included in the following Certification Programs:
16 CoursesCorporate Property Insurance Certification
- Introduction: Excellence in Claims Handling
- How to Acquire a First-Party Property Insurance Policy
- How to Read and Understand an Insurance Policy
- The Necessity of an Honest and Complete Insurance Application
- The Basics of the Law of Contracts for the Insurance Professional
- Ethics for the Insurance Professional
- What is the Problem with Fraud?
- Interviewing Techniques for the Insurance Professional
- Investigation of a First-Party Property Insurance Claim
- The Creation of a Scope, Statement, and Proof of Loss
- The Duties of an Insured Presenting a First-Party Property Claim
- The Insurance Examination under Oath (EUO)
- Insurance Fraud Prevention
- Compliance with Special Investigation Unit Regulations
- Compliance with Good Faith Settlement Practices Regulations
- The Obligations of a Public Insurance Adjuster
2 Reviews (7 ratings)Reviews
Paige Jones
(Owner at AHF Consultants)
This course was very clear and concise. A good review of how insurance fraud is handled
Theodore Zeck
(Certified Public Accountant at Theodore R. Zeck, CPA)
Very easy course to get that last hour of CPE needed to renew.
Prerequisites
Course Complexity: Intermediate
No Advanced Preparation or Prerequisites are not needed for this course. However, it is recommended to take the other courses in the series prior to completing this one.
Education Provider Information
Company:
Illumeo, Inc., 75 East Santa Clara St., Suite 1215, San Jose, CA 95113
Contact:
For more information regarding this course, including complaint and cancellation policies, please contact our offices at (408) 400- 3993 or send an e-mail to .